Initiation and Duration of Laryngeal Closure During the Pharyngeal Swallow in Post-Stroke Patients
As a bolus enters the pharynx during the swallow, the airway is protected by laryngeal closure, a process characterized by approximation of the vocal folds plus approximation of the arytenoid cartilages to the base of the epiglottis. The purpose of this study was to measure initiation of laryngeal closure (ILC) and laryngeal closure duration (LCD) in three groups of subjects: (1) ten stroke patients who aspirated before and during the swallow (aspirators), (2) ten stroke patients who did not aspirate (nonaspirators), and (3) ten normal control subjects. Means and standard deviations of ILC and LCD were analyzed for both 5-ml and 10-ml thin-liquid boluses using a 100-ms timer during subsequent analysis of videofluoroscopic swallowing examinations. There were significant differences between aspirators and control subjects for both ILC and LCD, and significant differences between aspirators and nonaspirators for ILC. There were no significant differences between aspirators and nonaspirators for LCD. Both delayed ILC and reduced LCD were associated with post-stroke aspiration. Delayed ILC is a significant indicator of overall risk of aspiration. Clinical implications for these findings are discussed.
KeywordsSwallowing Laryngeal closure Stroke Aspiration Pharynx Deglutition Deglutition disorders
This work was performed at the School of Hearing, Speech and Language Sciences, Ohio University.
- 1.Logemann JA, Kahrilas PJ, Cheng J, Pauloski BR, Gibbons PJ, Rademaker AW, et al. Closure mechanisms of laryngeal vestibule during swallowing. Am J Physiol Gastrointest Liver Physiol. 1992;262(2 Pt 1):G338–44.Google Scholar
- 7.Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999;10:744–8.Google Scholar
- 17.Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Hear Speech Lang Sci. 1994;37(5):1041–59.Google Scholar
- 19.McCullough GH, Wertz RT, Rosenbek JC. Age, gender, size, consistency effects on swallowing function in adults between 21 and 99 years of age. Albuquerque, NM: the 10th Annual Dysphagia Research Society; 2001.Google Scholar
- 24.Logemann JA, Pauloski BR, Rademaker AW, Colangelo L. Super-supraglottic swallow in irradiated head and neck cancer patients. Head Neck. 1997;19(6):535–40. doi: 10.1002/(SICI)1097-0347(199709)19:6<535::AID-HED11>3.0.CO;2-4.CrossRefPubMedGoogle Scholar